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everett <br />e <br />City of Everett <br />0 <br />Sewer Application and 'Permit <br />No. 23930 DATE ��11/el <br />112] Harri�oa <br />Service Address <br />Billing Address <br />City, State, Zip <br />Owner (Mortgagor) <br />Billing Name <br />Connection By CltT of l��r�tt <br />CHART N0. � G����� <br />s ' V p <br />3 QS�O� <br />Utility Account Nu. <br />Permit Fee <br />no�� <br />Connection Charge(s) <br />001�� <br />Total Fee <br />Signed <br />Don Mf.11�s <br />DESCRIPTION: Sewer District <br />Lot Block Monthly Sewer Service. <br />Plat <br />Unplatted Description _ Monthly Sewer Constr. <br />Trunk <br />T...... Dormif• ��pair <br />SEE SKETCH ATTACHED <br />INSPECTION <br />>butting Lot Line <br />N,S,E,W <br />■, R. Th�al <br />4pproved By <br />CitV Engineer <br />E. E9ad <br />Issued By <br />�� l � /'1 i �� � . < . J`�L <br />Inspection By — <br />. P <br />Date l nspected >` � � � <br />rvo. 23930 <br />